Individual provider Active NPI

Mobolaji B Suleiman, MD

  • Geriatric Medicine (Internal Medicine) Physician
  • Kankakee, IL
National Provider Identifier
1184764086
Registry record updated Mar 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X
License
036119627 Issued in IL
Practice address
401 N Wall St Ste 102
Kankakee, IL 60901-2934
Phone
(815) 928-5090
Fax
(815) 928-5079
NPI assigned
Feb 8, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 29, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 036119627 IL
Geriatric Medicine (Internal Medicine) Physician 207RG0300X 036119627 IL Primary

Addresses

Primary practice location

401 N Wall St Ste 102
Kankakee, IL 60901-2934

Mailing address

401 N Wall St Ste 102
Kankakee, IL 60901-2934
Phone (815) 928-5090

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address msuleiman7931@Direct.riversidehealthcare.net Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, IN2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20080118000040 IL Practitioner - Geriatric Medicine 4082650585 Reassigns benefits to 1 organization
I20130216000039 IN Practitioner - Internal Medicine 4082650585 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Geriatric Medicine
Education
Other, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Riverside Health SystemGroup PAC ID 3274434717, 202 clinicians

Practice addresses (Care Compare)

401 N Wall St
Suite 102
Kankakee, IL 60901-2934
Phone (815) 928-5090

Hospital & facility affiliations

  • R.M.C. Home Health Care Home health agency, Peotone, IL, CCN 147400
  • Uplifted Care Hospice, Bourbonnais, IL, CCN 141556
  • Riverside Medical Center Hospital, Kankakee, IL, CCN 140186
  • Presence St Marys Hospital Hospital, Kankakee, IL, CCN 140155
  • Gilman Healthcare Center Nursing home, Gilman, IL, CCN 145347
  • Miller Health Care Center Nursing home, Kankakee, IL, CCN 145843

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Riverside Health System CurrentSince Oct 11, 2007 Accepting new patients
Apogee Medical Group Indiana PC Internal Medicine CurrentSince Nov 27, 2012 Accepting new patients
24 On Physician Partners, PC CurrentSince Oct 27, 2018 Accepting new patients
Riverside Health System CurrentSince Oct 11, 2007 Accepting new patients
Hospitalist Medicine Physicians of Wisconsin, LTD Internal Medicine Past Accepting new patients
Gibson Community Hospital Association Past Accepting new patients
Hospitalist Medicine Physicians of Richland County, LTD Internal Medicine Past Accepting new patients
Hospitalist Medicine Physicians of Franklin County, LTD Internal Medicine Past Accepting new patients

Locations

13000 Deerfield Pkwy
Ste 100
Alpharetta, GA 30004

318 Maxwell Rd
Ste 500
Alpharetta, GA 30009
Phone (770) 274-0473

400 S Kennedy Dr
Ste 200
Bradley, IL 60915
Phone (815) 933-0007

400 S Kennedy Dr
Bradley, IL 60915
Phone (815) 928-8050

720 S Crescent St
Gilman, IL 60938
Phone (815) 265-4255

401 N Wall St
Ste 102
Kankakee, IL 60901
Phone (815) 928-5090

611 S Division St
Peotone, IL 60468
Phone (708) 258-9058

105 S First St
Wilmington, IL 60481
Phone (815) 476-5210

1500 S Lake Park Ave
Hobart, IN 46342
Phone (219) 942-0551

520 S 7th St
Vincennes, IN 47591
Phone (812) 885-3280

Interoperability endpoints

  • Direct secure messaging: msuleiman7931@direct.riversidehealthcare.net

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170892800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616976000000",
    "number": "1184764086",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 N WALL ST STE 102",
            "city": "KANKAKEE",
            "state": "IL",
            "postal_code": "609012934",
            "telephone_number": "815-928-5090",
            "fax_number": "815-928-5079"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 N WALL ST STE 102",
            "city": "KANKAKEE",
            "state": "IL",
            "postal_code": "609012934",
            "telephone_number": "815-928-5090",
            "fax_number": "815-928-5079"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULEIMAN",
        "first_name": "MOBOLAJI",
        "middle_name": "B",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-08",
        "last_updated": "2021-03-29",
        "certification_date": "2021-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036119627",
            "primary": false
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "IL",
            "license": "036119627",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "msuleiman7931@Direct.riversidehealthcare.net",
            "affiliation": "N",
            "endpointDescription": "Direct, Secure Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "401 N Wall St Ste 102",
            "city": "Kankakee",
            "state": "IL",
            "country_code": "US",
            "postal_code": "609012934",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Kankakee, IL

Sources for this page

Verify at the official NPI Registry.